Healthcare Provider Details

I. General information

NPI: 1619030509
Provider Name (Legal Business Name): ANDREA CHRISTIN BUMP LMP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/19/2006
Last Update Date: 03/17/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3201 NORTHWEST AVE SUITE 8
BELLINGHAM WA
98225-1363
US

IV. Provider business mailing address

4509 LAKEWAY DR
BELLINGHAM WA
98229-5117
US

V. Phone/Fax

Practice location:
  • Phone: 360-319-5286
  • Fax:
Mailing address:
  • Phone: 360-319-5286
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA00021889
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: